Last month we talked about the importance of the “dynamic” bike fit. Looking at how individuals fit their bikes and how they move on them in order to help reduce low back pain while riding. These same principles can help alleviate pain in other areas common to cyclists, such as the neck and shoulder.

The neck and shoulder are often reported as the most common areas of discomfort in cyclists; especially for recreational riders or those new to the sport. One study found that 66.4% of amateur riders reported some symptoms of neck and shoulder pain on a questionnaire, while another study by Wilber and colleagues found 48.8% of those asked reported non-traumatic neck pain due to cycling.

When we look at the riding position of cyclists, discuss anatomy, and the forces involved to maintain proper position, there is no surprise why cyclists commonly get neck and shoulder pain. Riders need to lean their trunk forward to reach the handle bars, and this lean creates a flexion moment (the head wants to drop down) which must be counteracted by the cervical extensor muscles on the back of the neck.

This flexion moment is greater on road and triathlon bikes where riders need to lean farther forward, especially while using drops, which means the muscles on the back of the neck need to create more force to hold the neck in place. A study done by Kolehmainen et al showed that the flexion moment created in a “racing” position was three times greater than in an upright riding position.

Because the cervical extensors must maintain a contraction the entire time to keep the head in place, and riders will often ride for multiple hours many times a week, over-use of these muscles is a common source of pain in cyclists.

Other structures in the neck that can be sources of pain are the joints, called facet joints, and nerves that exit the cervical spine and go down to each respective arm. In order to maintain a visual field of the road, the neck needs to extend about 30 degrees. This amount of extensions causes the facet joints in the neck to close down and increase in load, which may be a source of pain. This also decreases the foraminal space where nerve roots exit the spine, and pinched nerves is also a common source of neck and shoulder pain.

With an improper bike fit, or poor trunk positioning, riders will often need to increase their cervical extension beyond the 30 degrees to see the road, which increases the amount of strain on the muscles, joints, and nerves of the neck. Often times, cyclists will have excessive curvature in their low and mid-back (called kyphosis), which means the cervical spine needs to extend more to maintain head position. This excessive kyphosis can be due to a few factors: poor handle bar position, incorrect seat height or tilt, shortened hamstrings causing posterior pelvic tilt, decreased paraspinal strength or endurance, or it may be an inherent part of a rider’s anatomy.

An interesting point to make when it comes to neck and shoulder pain in cyclists is how much less professional riders experience neck pain. In the elite cycling population, riders only reported experiencing non-traumatic neck pain 10.6% of the time per Clarsen et al. This is not only significantly less than inexperience riders, but also less than the general population who report neck pain on an annual incidence of 14.6%.

There have been many hypotheses as to why experienced riders experience less cervical pain than amateurs; such as, better fitting bikes, cervical extensor strength, cervical extensor endurance, and range of motion. A study by Jacobs et al was performed to better understand these factors. They found that there was no significant difference in cervical extensor strength between recreational and experienced riders. A more important factor may be endurance of these muscles rather than overall strength.

No matter if you’re a recreational or professional cyclist, if you’re experience neck and/or shoulder pain while riding and looking for a comprehensive examination that looks at your bike fit, anatomy, and muscle activation, check out Competitive Edge Physical Therapy! We use advanced biomechanical motion capture technology to ensure the best dynamic fit to your bike, and muscle EMG feedback to show proper muscle activation in exercising and riding position.

Feel free to check out our bike fit information at www.compedgept.com or schedule a free consultation to meet our physical therapists and see our clinic in San Jose, CA 408-784-7167.